Provider Demographics
NPI:1861485245
Name:LARSON, SIGRID A (MD)
Entity Type:Individual
Prefix:MS
First Name:SIGRID
Middle Name:A
Last Name:LARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3542 WELSH RD
Mailing Address - Street 2:NE PHYSICIAN SERVICES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2623
Mailing Address - Country:US
Mailing Address - Phone:215-333-6888
Mailing Address - Fax:215-333-3945
Practice Address - Street 1:9625 FRANKFORD AVE
Practice Address - Street 2:NE PHYSICIAN SERVICES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2846
Practice Address - Country:US
Practice Address - Phone:215-637-9400
Practice Address - Fax:215-637-7970
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD420932207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019564760001Medicaid
PA1472127OtherIBC
PALA1472127OtherBLUE SHIELD
P00048396OtherRR MEDICARE
P2928460OtherOXFORD
PA30008940OtherKEYSTONE MERCY
PA2155650000OtherKEYSTONE
PA7273442OtherAETNA
H84709Medicare UPIN
PALA1472127OtherBLUE SHIELD